Provider Demographics
NPI:1528414141
Name:REORDAN, BRET KIRK (DPT)
Entity Type:Individual
Prefix:
First Name:BRET
Middle Name:KIRK
Last Name:REORDAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 N. 5TH ST.
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97530
Mailing Address - Country:US
Mailing Address - Phone:541-899-8179
Mailing Address - Fax:541-899-0244
Practice Address - Street 1:635 N. 5TH ST.
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97530
Practice Address - Country:US
Practice Address - Phone:541-899-8179
Practice Address - Fax:541-899-0244
Is Sole Proprietor?:No
Enumeration Date:2016-05-12
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR61643225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500708227Medicaid
ORR188359Medicare PIN